Summer Series exam guide |June/July 2026| Mental
Health Nursing |Midterm Examination|Questions
And Correct Answers
1 A 28-year-old patient with major depressive disorder reports new-
onset visual hallucinations and severe insomnia after three weeks of
starting sertraline. What is the most appropriate immediate nursing
action?
A. Increase the sertraline dose to achieve therapeutic effect.
B. Reassure the patient that vivid dreams are common and document
the symptom.
C. Assess for signs of serotonin syndrome and notify the prescriber
immediately.
D. Advise the patient to stop sertraline and begin an over-the-counter
sleep aid.
Correct Answer: C
Explanation: Sertraline can—rarely—contribute to serotonin syndrome,
which may present with hallucinations, agitation, and autonomic
instability; assessment and prescriber notification are urgent. Options A
and B are inappropriate because escalating or dismissing symptoms
risks harm. Option D is incorrect because abrupt cessation or self-
medicating with OTC sleep aids can be unsafe.
2 A patient with schizophrenia remains mute and holds a rigid posture
for long periods but responds to the nurse’s gentle touch with a brief
smile. Which symptom cluster does this behavior best illustrate?
A. Positive symptoms.
,B. Cognitive symptoms.
C. Negative symptoms.
D. Catatonic features.
Correct Answer: D
Explanation: Rigid posture and mutism are classic catatonic features; a
brief smile after touch does not negate catatonia. Positive symptoms are
hallucinations/delusions, cognitive symptoms affect thinking, and
negative symptoms include affective flattening and social withdrawal
but not the motor immobility seen here.
3 During a suicide risk assessment, a client denies current suicidal
ideation but states: “If things don’t get better, I won’t be here in a few
months.” Which element makes this statement most concerning?
A. Passive ideation with a future time frame.
B. Lack of a specific plan.
C. The client’s denial of intent.
D. Presence of hope for change.
Correct Answer: A
Explanation: Passive suicidal ideation that implies a future intent
(“won’t be here”) indicates risk and warrants further assessment and
safety planning. Absence of a specific plan (B) and denial of intent (C)
reduce but do not eliminate risk. D is incorrect because the statement
reflects hopelessness, not hope.
4 A hospitalized patient with bipolar I disorder is acutely manic and
pacing rapidly, interrupting others, and refusing oral medication. What
is the most appropriate first-line nursing intervention?
,A. Offer an oral antipsychotic again and threaten seclusion if refusal
continues.
B. Use a calm, firm approach to set short, clear limits and offer a stat
intramuscular medication per orders if refusal continues.
C. Allow the patient to pace freely to avoid escalation and postpone
medication.
D. Transfer the patient immediately to seclusion without further
attempts at de-escalation.
Correct Answer: B
Explanation: Setting clear limits and attempting least-restrictive
interventions is appropriate; if refusal continues, administering an
ordered IM medication may be necessary for safety. Threats (A) and
immediate seclusion (D) bypass de-escalation and patient rights.
Allowing unchecked pacing (C) risks harm.
5 A 65-year-old patient with new-onset delirium is disoriented, has
fluctuating levels of consciousness, and visual hallucinations. Which
factor most commonly precipitates delirium in older adults?
A. Chronic schizophrenia.
B. Acute medical illness or infection.
C. Long-standing depression.
D. Social isolation.
Correct Answer: B
Explanation: Acute medical conditions (e.g., infection, metabolic
disturbances) are the most common precipitants of delirium in older
adults. Chronic psychiatric illnesses (A, C) and social factors (D) may
contribute to vulnerability but are less commonly direct precipitants.
, 6 A nurse uses the Mental Status Examination (MSE). Which area
assesses a client’s ability to perform executive tasks such as abstraction
and problem solving?
A. Appearance and behavior.
B. Thought content.
C. Cognitive function.
D. Mood and affect.
Correct Answer: C
Explanation: Cognitive function on the MSE evaluates orientation,
attention, memory, and higher functions like abstraction and problem
solving. Appearance/behavior (A), thought content (B), and mood/affect
(D) assess other domains.
7 A patient on lithium therapy asks how the drug works. The best
concise explanation is:
A. "Lithium increases dopamine to improve mood."
B. "Lithium stabilizes mood by modulating neurotransmitter signaling
and intracellular second messengers."
C. "Lithium is a sedative that prevents mania by causing drowsiness."
D. "Lithium blocks serotonin receptors selectively."
Correct Answer: B
Explanation: Lithium’s mood-stabilizing effects involve complex
modulation of neurotransmitters and intracellular signaling pathways. It
is not primarily a sedative (C), does not selectively block serotonin
receptors (D), nor does it simply increase dopamine (A).
Health Nursing |Midterm Examination|Questions
And Correct Answers
1 A 28-year-old patient with major depressive disorder reports new-
onset visual hallucinations and severe insomnia after three weeks of
starting sertraline. What is the most appropriate immediate nursing
action?
A. Increase the sertraline dose to achieve therapeutic effect.
B. Reassure the patient that vivid dreams are common and document
the symptom.
C. Assess for signs of serotonin syndrome and notify the prescriber
immediately.
D. Advise the patient to stop sertraline and begin an over-the-counter
sleep aid.
Correct Answer: C
Explanation: Sertraline can—rarely—contribute to serotonin syndrome,
which may present with hallucinations, agitation, and autonomic
instability; assessment and prescriber notification are urgent. Options A
and B are inappropriate because escalating or dismissing symptoms
risks harm. Option D is incorrect because abrupt cessation or self-
medicating with OTC sleep aids can be unsafe.
2 A patient with schizophrenia remains mute and holds a rigid posture
for long periods but responds to the nurse’s gentle touch with a brief
smile. Which symptom cluster does this behavior best illustrate?
A. Positive symptoms.
,B. Cognitive symptoms.
C. Negative symptoms.
D. Catatonic features.
Correct Answer: D
Explanation: Rigid posture and mutism are classic catatonic features; a
brief smile after touch does not negate catatonia. Positive symptoms are
hallucinations/delusions, cognitive symptoms affect thinking, and
negative symptoms include affective flattening and social withdrawal
but not the motor immobility seen here.
3 During a suicide risk assessment, a client denies current suicidal
ideation but states: “If things don’t get better, I won’t be here in a few
months.” Which element makes this statement most concerning?
A. Passive ideation with a future time frame.
B. Lack of a specific plan.
C. The client’s denial of intent.
D. Presence of hope for change.
Correct Answer: A
Explanation: Passive suicidal ideation that implies a future intent
(“won’t be here”) indicates risk and warrants further assessment and
safety planning. Absence of a specific plan (B) and denial of intent (C)
reduce but do not eliminate risk. D is incorrect because the statement
reflects hopelessness, not hope.
4 A hospitalized patient with bipolar I disorder is acutely manic and
pacing rapidly, interrupting others, and refusing oral medication. What
is the most appropriate first-line nursing intervention?
,A. Offer an oral antipsychotic again and threaten seclusion if refusal
continues.
B. Use a calm, firm approach to set short, clear limits and offer a stat
intramuscular medication per orders if refusal continues.
C. Allow the patient to pace freely to avoid escalation and postpone
medication.
D. Transfer the patient immediately to seclusion without further
attempts at de-escalation.
Correct Answer: B
Explanation: Setting clear limits and attempting least-restrictive
interventions is appropriate; if refusal continues, administering an
ordered IM medication may be necessary for safety. Threats (A) and
immediate seclusion (D) bypass de-escalation and patient rights.
Allowing unchecked pacing (C) risks harm.
5 A 65-year-old patient with new-onset delirium is disoriented, has
fluctuating levels of consciousness, and visual hallucinations. Which
factor most commonly precipitates delirium in older adults?
A. Chronic schizophrenia.
B. Acute medical illness or infection.
C. Long-standing depression.
D. Social isolation.
Correct Answer: B
Explanation: Acute medical conditions (e.g., infection, metabolic
disturbances) are the most common precipitants of delirium in older
adults. Chronic psychiatric illnesses (A, C) and social factors (D) may
contribute to vulnerability but are less commonly direct precipitants.
, 6 A nurse uses the Mental Status Examination (MSE). Which area
assesses a client’s ability to perform executive tasks such as abstraction
and problem solving?
A. Appearance and behavior.
B. Thought content.
C. Cognitive function.
D. Mood and affect.
Correct Answer: C
Explanation: Cognitive function on the MSE evaluates orientation,
attention, memory, and higher functions like abstraction and problem
solving. Appearance/behavior (A), thought content (B), and mood/affect
(D) assess other domains.
7 A patient on lithium therapy asks how the drug works. The best
concise explanation is:
A. "Lithium increases dopamine to improve mood."
B. "Lithium stabilizes mood by modulating neurotransmitter signaling
and intracellular second messengers."
C. "Lithium is a sedative that prevents mania by causing drowsiness."
D. "Lithium blocks serotonin receptors selectively."
Correct Answer: B
Explanation: Lithium’s mood-stabilizing effects involve complex
modulation of neurotransmitters and intracellular signaling pathways. It
is not primarily a sedative (C), does not selectively block serotonin
receptors (D), nor does it simply increase dopamine (A).
